Abstract: While exposure to traumatic psychological and physical trauma can produce post-traumatic stress disorder (PTSD), multiple factors determine whether a person will develop PTSD following trauma exposure. Such factors include, but are not limited to, female gender, social disadvantage, childhood adversity, genetic predisposition, and substance abuse. PTSD has a high rate of comorbidity with psychiatric, substance abuse, and somatization disorders. Persons with PTSD experience profound and persistent alterations in their physiological reactivity to…internal and external stimuli which prevents them from utilizing their emotions to process incoming information. These patients have chronically high levels of sympathetic nervous system activity and low levels of glucocorticoids to cope with stress and modulate their catecholamine levels. Neuropsychological assessment of patients with PTSD depends to a large degree on the sensitivity of the measures which are utilized and a pre-existing history of learning disabilities, head trauma, and/or neurological disorders. While closed head injuries (CHI) are unlikely to produce PTSD symptoms, persons with CHI are likely to develop PTSD symptoms if they are exposed to trauma prior to the onset of retrograde amnesia or after the resolution of post-traumatic amnesia. If the traumatic event occurs while the patient with CHI is amnestic or unconscious, they are unlikely to develop PTSD symptoms. The liberal criteria used to diagnose mild CHI is likely to result in patients with acute stress disorders being misdiagnosed with CHI as a result of their dissociative symptoms which reduce their awareness and encoding of the traumatic event.
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Abstract: Clinical And forensic evaluators need to be able to recognize variations of syndromes that ``don't read the textbooks.'' Atypical presentations of postconcussion syndrome (PCS) and posttraumatic stress disorder (PTSD) after traumatic brain injury (TBI) have the potential to cause much confusion in diagnosis, treatment planning and legal adjudication, if not correctly recognized. This paper reviews the typical and atypical presentations of PCS, PTSD, and other psychological responses to TBI and other traumatic…disability syndromes that may be encountered in clinical practice. Throughout, the emphasis is on the optimum combination of parsimony and comprehensiveness in diagnostic and clinical decision-making.
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Abstract: With increasing efforts to control health care costs, inpatient rehabilitation lengths of stay have steadily decreased in the United Sates. With less time allotted to each patient, emphasis is now placed on managing medical complications and achieving independence in self-care activities. Addressing the psychological needs of the patient with neurological problems has necessarily become less of a priority for the rehabilitation team. This manuscript describes a framework for addressing the psychological and…rehabilitation needs of persons with neurological disabilities in the short- and long-term, within and outside the hospital setting. The Laws of the House of Rehab can serve as a framework for developing ethical principles and values as a rehabilitation provider. Organized by content areas, the laws encompass practice fundamentals, assessment and history taking, treatment planning, treatment, and communication. Some describe principles of practice that relate to all phases of rehabilitation. The laws can be used to guide intervention, promote emotional recovery, enhance the benefits of interdisciplinary rehabilitation, and enhance the fulfilling aspects of practice.
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Abstract: The MMPI-2 serves an integral role in a comprehensive psychological evaluation of persons with traumatic brain injury because it provides clinically relevant information regarding the presence of psychiatric illness, adaptation to the injury, and potential interpersonal strengths or liabilities that may impact the rehabilitative process. Importantly, the MMPI-2 provides critical information regarding the accuracy of patient self-report and the tendency to either exaggerate or minimize symptoms. However, the MMPI-2 contains items that…are directly related to the cognitive sequalae of brain injury. As a result, concerns have been raised regarding the appropriateness of the MMPI-2 for use with brain injured patients. We discuss evidence that supports the use of the MMPI-2 with brain-injured patients and the concerns over the applicability of the MMPI-2 in this population. Further, we critically discuss recently proposed strategies to correct the MMPI-2 for neurologically related items (NRI) in brain injured populations in terms of the clinical application of such procedures, the benefits and limitations of such procedures, and the need for further refinement and validation of these correction factors.
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Abstract: The neurobehavioral sequelae of electrical injuries (EI) are relatively misunderstood and patients present with diverse symptom patterns. Traditionally, emphasis has been directed toward treating the physical consequences of these injuries, while failing to address the cognitive, emotional, and behavioral disturbances that follow. This often results in significant disruptions to a patient's vocational life and psychosocial well-being. The present paper will compare and contrast the general effects of trauma and the specific effects…of electrical injury; look at the ``obvious versus subtle'' distinction; return to work issues; the psychologic impact of the injury; and some challenges and recommendations for treating the resultant cognitive, emotional, and behavioral disturbances in these patients.
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